Saturday, December 17, 2016

Gender Dysphoria in Modern Culture
With recent political swings, general public interest, and a growing community, it is more important now than ever to discuss Gender Dysphoria, more commonly known as Transgender individuals, both in a clinical use and cultural sense. Full disclaimer: this is an extremely volatile, heated debate and it is one I am a fully biased in. I will try my hardest to keep any strong opinions from leaking through, but in reality, this is bound to happen on some level.
Firstly I’d like to define what Gender Dysphoria is. The Diagnostic and Statistical manual of mental disorders IV (DSM-5) plainly defines Gender Dysphoria as “people whose gender at birth is contrary to the one they identify with”. This is the most basic, umbrella term that still conveys the idea of dissatisfaction with ones at birth sex. While this definition is generally agreed upon, it leaves two keywords undefined.
“Gender at birth” is used instead of the much more common term “sex”, your sex being determined by firstly genetic makeup (XX chromosome/ XY chromosome, or the more present one in cases of multiple chromosomes), secondly by the presence of genitalia corresponding to one of the two binary genders (nonbinary will be discussed at a later point) and lastly by other physical attributes such as breast tissue, hair growth patterns, muscle/fat distribution, etc.  To put it simply, your nonmental and physical attributes determine what sex you are with very little medical abilities available to change it.  The second term, “Identify” or “Gender Identity” is slightly trickier to explain. Gender Identity refers to how one sees him/her/them/xi/ci/elves and how said person wishes to be seen, treated and act according to. While in a typical sense this refers to an at birth male wishing to be a female or vice versa, in the recent decade it has been discovered many more gender identities are possible to develop than the traditional binary roles.
Now in whole, symptoms of Gender Dysphoria vary wildly and extremely based on social position, political/social views, and/or sex; however, there are a few general placements we can put to begin a general evaluation and help determine wants from psychological needs.
In young (at birth) males (children 4-11 years or pre-puberty) the most present and common symptom is a feeling that one day they will no longer be a boy, a strong idea that gender is a timer and one day they This is where you get the classic comedic idea of “When I grow up I want to be a girl!” when the teacher quizzes the preschoolers . I remember from my own childhood a very strong and constant thought that gender was more of a flip flop thing. No one stayed a boy forever, that was obviously ludicrous. From that I often had a vivid fantasy about all the toys I would have and all the girly things I would do when my clock finally hit pink. Short of that, a strong and consistent urge to participate female clothing, ¨strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex¨(DSM-IV, Gender Dysphoria) and a strong aversion from rough and tumble play, preferring softer less physical games.
In young (at birth) women (children 4-11 years or pre-puberty) it is exhibiting by a refusal of sitting in a urinating position, to the point of anger or tears. It also consists of a strong insistence that they will produce or grow male genitalia.
In adolescents, the signs mature to a different degree. It should be noted that it is possible that individuals can mature away from gender dysphoria through puberty due to the rush of hormones that accompany it, however; those who do not are shown to exhibit a much high chance of depression, anxiety, and being anti-social than their cis(that is, those who identify with their sex) peers. For more than a six month period, a subject must exhibit a consistent want(or psychological need) to be treated as and act like the opposite gender.
There is also, in some subjects, a strong intense hatred of their body, particularly those aspects that are affiliated with the opposite gender (Hoover-31). From personal experience, I can say this is one of the most difficult things for non-trans individuals to understand. The first, most important note is that every individual feels this in their own way, with their own emotions and consistencies. So it is impossible to accurately describe this feeling across a wide and diverse population but I can certainly describe my own. At best, it leaves itself as a near constant deep discomfort. A feeling of being locked in a dark cellar with no door or comforts, all but a single window to which one can peer at the great castles laying upon the hills while never being able to reach them. It is the feeling of utter hopelessness. Now, in contrast, you have the aggressive depression. The days when I look in a mirror and scream at the monstrosity staring back at me. The days I feel like I’m in the stomach of a monster who won’t let me out. The days when your “man hair” feels like a billion tiny needles injecting you with despair. The days when the only reason you don’t peel your skin off is the length of your fingernails. Those are the darkest days.
It is shown that transgender people have a significantly increased chance of severe depression and anxiety(Dentato-Minority Stress Perspective). This is very typical for a minority group, however, the rates and severity are drastically increased. The average rate of successful or attempted suicide in transgender youth is ¬44%(Malone-Trans suicide rates are staggering). To put that in comparison, the average for the middle class, white families is 14%, which is one of the highest groups in the country(AFSP-Suicide rates 2015).
The theories surrounding why this is are very generalized and widely unproven. This is due to the simple fact that depression, like many other things, is experienced uniquely by each individual in their own different and special way. However, in the update from DSM four to DSM five, it is stated that any form of depression or anxiety does not actually originate from being trans in and of itself  but societies view and expectations of them that cause such disturbance in mental process   
Individuals may or not seek counseling to help cope with the transition process, either for daily life or any deeper rooted mental disorder that's come about due to it. One typically stays in counseling for the majority of the transition period, which normally lasts one to two years, and is required to begin a medical transition.
Now medical transitioning is separated into four parts. The first two are separated into “top” and “bottom”. In trans men, top surgery implies the removal of breast tissue via an incision in the lower chest(average cost-$4000) while bottom surgery implies the creation of a neoplastic penile structure. For trans women, top surgery implies an incision either to the side or bottom of existing chest cavities to implement realistic implants(~2,500 dollars). While bottom, or Vaginoplasty, is the creation of a vagina like an apparatus (~$12,600).


The most common and sought after form of medical transition is that of Hormone Replacement Therapy (shortened: HRT). The endocrine system is responsible for emitting hormones into the body's bloodstream. In males, this system typically releases testosterone, a chemical responsible for emotional aggression, muscle growth, and sexual depth. It's counterpart, estrogen, is emitted within the female sex more prominently as it creates emotional depth, and establishes secondary female aspects such as muscle distribution, hairline and more prominent underarm/pubic hair and less prominent sexual arousal.
When undergoing HRT an individual begins to experience physical and mental changes typical for the opposite sex. While there are some things it simply cannot change, such as facial structure, height, bone structure, for trans women vocal depth, and trans men the voice is changed only slightly. However; trans men will begin experiencing facial/chest hair, large muscle growth, particularly behind the femur and mental aspects experienced by cis males.
In trans women, a great decrease in muscle growth(seriously I've lost like fifteen pounds of the stuff), increased fat in the lower abdomen, hips and in front of the femur as well as petite breast tissue growth. Over a two-year period, providing for the therapy, medicine itself, doctor's appointments the bill comes out to about 3,000 with no direct surgery that is almost never covered by insurance.
It should also be noted that trans people do not always follow the binary role, that does not identify as male or female. These people, often labeled as non-binary or genderqueer, tend to be a result of a mix of estrogen and testosterone leading to an identification that is somewhere outside and in between male and female. These individuals often find themselves in a position of oppression and invalidation(David- Physics teacher refuses to debate), despite the fact multiple research studies have this to be a real psychological event that affects a large majority of the transgender population(Psychology Today- None of the above).
While some nonbinary individuals relate more so to one gender then the inverse of said one, but each individual may or may not experience dysphoria in their own individual cases. These spurts of dysphoria tend to be directed at a both binary genders aspects, but only certain parts. While some people may wish to be rid of their facial hair another would relish it, some may crave to have chest tissue while others have attempted to claw theirs off. Non-binaries are notoriously difficult to analyze due to their non-standard, crazy or otherwise atypical behavior.  These individuals also commonly present a linguistic challenge, as there is no third to he/she. In the cause of this, most nonbinary individuals will go by ẗhey/them, extending it to include a single individual in more cases. Others have suggested adding ze/zem or xe/xem to compensate for this.
Gender fluid individuals, on the other hand, are the chimera of scientific gender explanation. No one is quite sure what causes this abnormality; however, a gender fluid individual is one who changes their identity and is dynamic over the course of a period of time. These individuals experience what is known as dynamic dysphoria(Gender Fluid Generation- Evolving Gender Norms). That is, while on a day they may feel deeply that they hate their breast tissue another day they will feel incredibly comfortable being female, proud in fact, and on another, they may wish to be neither. Due to this overly dynamic nature, many gender fluid individuals tend to not receive any form of re-assignment surgery. Some will begin HRT to give themselves more androgynous appearance. These cases are exceptionally rare due to the strong dynamic changes that come with being genderfluid.

Overall, Dysphoria has come a long way since the days of shock therapy and exorcisms but that process is far from being over. If we all just took a little time out of our lives to inform ourselves, we could improve the lives of 1.4 million people in the U.S, as well as allow ourselves to be a more modern, more educated, and a freer individual.